CASE PRESENTATION 1
Case Presentation: First Client
Cameron G Rasnake
School of Behavioral Sciences, Liberty University
CASE PRESENTATION 2
Client Information
My client is a 63-year-old Caucasian female. She has worked several jobs in her life but
the longest one was her career as a nurse (RN) and then as a sales manager at J.C. Penney’s. She
is currently on disability/early retirement, but she has expressed an interest in going back into the
workforce. She has been divorced twice and is currently single. She has one child, a daughter, in
her thirties. Her father has passed away, but her mother is still living and remarried. She and her
mother are very close.
Presenting Problem
My client has a lengthy history of alcoholism. It has strained practically all the
relationships in her life at some point or another, and she came to seek counseling in an effort to
heal and repair those relationships, as well as work on herself and learn coping mechanisms. She
was sober for a while but relapsed about two months ago, causing her daughter to become very
upset and move away from her. The ct wants to learn how to deal/cope with stressors in her life
without using alcohol. She has had several various alcoholism treatments. Ct reports several
symptoms related to anxiety, depression, and OCD tendencies. Mild to moderate impaired
functioning.
Diagnostic Impression
Alcohol use disorder (F10.20) Severe
Obsessive-compulsive disorder (F42.2)
Generalized anxiety disorder (F41.1)
Bipolar I disorder, most recent episode manic, moderate (F31.12)
From the get-go I noticed my client had several symptoms and neurological problems,
but it was difficult to narrow them down. I talked to my supervisor about it and read through the
CASE PRESENTATION 3
DSM-5-TR for quite a while. I even had some trouble specifying certain criteria like how severe
some of her issues were, because I do not have the extensive history with her like my supervisor
(her regular therapist) does. I did, however, come to some conclusions and I believe I made the
right choices. During the three sessions we have had together, I have seen several symptoms for
each of the diagnoses. I based my decision on my observations and her self-reporting to me
during the sessions.
Session Description
This was our third session together and second attempt at recording. The client was open
with me from the very first session; my supervisor even noted how she was so open with me. She
is outgoing and extroverted and seemed to take a liking to me fairly quickly. She was happy to
meet me and eager to help me with the recording. We were quite rushed on the day we tried to
record the session, plus my seasonal allergies were getting the best of me, so we decided to
record another session. It went much better. The client shared two very personal situations with
me that she had never shared with my supervisor/her therapist before. I was honored.
Skills Competency Scale
Basic Skills
Not Present Minima
l
Proficien
t
Advance
d
Eye contact, verbal tone, and attending
skills
Facial expression and gestures
Appropriate Minimal Encouragers
Empathy
Being non-judgmental/unconditional
positive regard
Active listening
Open-ended questions
CASE PRESENTATION 4
Reflection (feelings, meaning, content)
Paraphrasing
Summarizing
Attentive silence
Challenging/Confrontation
Immediacy
Self-Disclosure
Goal setting
Wrapping up the session
Assessment of Therapeutic Relationship
To be quite honest, I feel like our relationship is strengthened after this past session. My
client shared two very personal situations with me where she had to be quite vulnerable. I feel
like our therapeutic rapport was strengthened and trust was gained. The things she shared with
me were heavy things that she had not yet shared with other therapists/friends/family. I feel very
grateful that she chose to be vulnerable and open with me. I believe it benefitted our relationship.
Counselor Self-Assessment
While I certainly feel like this session went better than the first one that we recorded, I
still feel like I could have done a lot better. For starters, my client is very talkative and has a
tendency to get started on a rabbit trail in conversation. She is also difficult to interrupt—I
struggled with finding times to interject myself into the conversation. Sometimes I thought to
myself, okay, what does this have to do with the session? But I feared coming off as rude and
inconsiderate, so I just let her talk. I would like to work on that in the future. There were also
sometimes I debated on whether I should use attentive silence or not—sometimes I worried it felt
awkward. But I believe it was probably for the best. For example, when my client told me about
one of the very personal situations, I used attentive silence during one point. For a second it felt
awkward, and I feared I made the wrong choice, but I think the client needed to sit with it after
telling me. Also, for fear of coming off as judgmental, I did not want to ask too many questions
CASE PRESENTATION 5
or probe too much—so I chose to remain silent. In the future I would like to learn what the best
thing to do would be. Either sit in attentive silence, or ask questions that let the client know you
want to understand more. Perhaps my classmates can give some advice on how to handle when a
client shares a personal and heavy moment/situation. very
Reference
American Psychiatric Association’s (2013) Diagnostic and Statistical Manual of Mental
Disorders (5th ed.; DSM-5)
